Amputation or Limb Salvage in Combat Trauma: Surgical Decision-Making

Limb salvage and amputation are not opposing philosophies — both are parts of the same strategy for treating devastating extremity trauma.

Through real combat injury cases, the lecture examines primary, secondary and late amputation, tourniquet management, staged debridement, infection control, vascular injury and ischemia, stump planning, and the consequences of premature wound closure. Particular attention is given to the practical limits of scoring systems such as MESS: useful tools for structured thinking, but not automatic indications for amputation.

The central question goes beyond whether a limb can technically be reconstructed. What function can realistically be achieved after months of operations? What is the risk of recurrent infection, loss of protective sensation or chronic pain? And does that outcome match the patient's work, expectations and rehabilitation possibilities?

The cases show why a technically impressive reconstruction can still be the wrong operation — and why thoughtful amputation can sometimes return a patient to mobility much sooner. The discussion also explores negative-pressure wound therapy, local wound management and the demanding prerequisites for heel and foot reconstruction.